Characteristics of amplitude-integrated electroencephalography in neonates with excessive hyperbilirubinemia Division of Neonatology, the Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China and Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA Courtesy: Fang Luo, Vinod K. Bhutani, Lizhong Du et al

Acute Bilirubin Encephalopathy Severity (Score)Mental StatusNeuro-motorCry Mild (1 for each)Sleepy, poor feeding Neck stiffness, mild hypertonia High-pitched Moderate (1 for each)Lethargy, Irritability Arching: retrocolis,Shrill Severe (1 for each)Semi-coma; Seizures, Coma OphistotonosInconsolable/ weak Referred AABR (unilateral or bilateral = Bilirubin Neurotoxicity Score range of 0-3 indicates mild ABE and is mostly reversible Score range of 4-6 is moderate ABE and can be reversible with urgent intervention Score range of 7-9 is severe ABE and is mostly irreversible. BIND Score: Johnson & Bhutani. Journal of Perinatology: 2012

Preliminary Study Report Study Objectives:To identify patterns of acute changes in aEEG in neonates with progressive and severe hyperbilirubinemia and correlate their post-icteric sequele. Methods: aEEG records of 21 term and late preterm infants with hyperbilirubinemia (GA: 35-42weeks) were analyzed to calculate cerebral function monitoring scores. Clinical follow-up included examination, Brainstem Auditory Evoked Potential (BAEP) and magnetic resonance imaging (MRI). Developmental outcome was assessed by e Infant Neurological International Battery (INFANIB) tests during acute phase and follow-up (>3 months; range 3-12 months).

aEEG tracings (n=21) Continuous normal voltage (n= 15), Discontinuous voltage (n=4) Burst–suppression (n=2) Mature S/W/C (SWC; n=7), immature SWC (n=7), no SWC (n=7); Seizures: 12 infants (57%) – single seizure (n=5); – repetitive seizures (n=5) – status epilepticus (n=2).

Follow-up Normal outcomes: 9/21 infants with normal aEEG. Of the remainder 12 with abnormal aEEG, – Normal (2): TB levels: 23.86±3.2 ( )mg/dl, – Abnormal outcomes (10): TB 37.22±4.6 (29.94~43.07) mg/dl spastic dyskinesia (2), Hypotonia (8) Hearing loss (2).The TB for infants with normal outcomes was and with abnormal outcomes was aEEG was recorded continuously during exchange transfusions period in 7 infants: 2 improved to CNV from NV or BS+, 2 developed seizures and in 3 infants electric activities decreased.

Summary aEEG patterns did not appear to have bilirubin load correlation Identified those with abnormal acute pattern of changes. Occurrence of undetected seizures is higher than previously not reported in literature aEEG could be predictive for future abnormal neurological outcome.